高压氧在成人烟雾病治疗中的应用

摘要

目的 探讨高压氧(hyperbaric oxygen therapy,HBOT)在成人烟雾病治疗中的应用价值.方法 回顾性纳入2009年3月至2016年12月于首都医科大学附属复兴医院高压氧科收治的成人烟雾病病人,分析其临床资料,高压氧治疗后神经功能变化,治疗期间新发脑血管事件以及随访90 d的预后.神经功能缺损采用美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS),预后评分采用改良Rankin量表(Modified Rankin Scale,mRS).结果 共纳入13例成人烟雾病病人,其中缺血型8例,出血型5例,缺血型中4例累及双侧大脑半球,4例累及一侧半球,5例此次发病接受了颅内血运重建手术,4例术后出现新发脑梗死.出血型中3例单纯脑室出血,2例脑内出血破入脑室,全部病人接受血肿清除和(或)脑室穿刺术.HBOT前所有病人神经功能均严重受损,HBOT次数最少5次,最多40次,HBOT后12例病人临床症状得到改善,无效1例,2例治疗期间出现新发脑梗死,90 d预后良好10例(mRS≤3分).结论 HBOT有效减轻成人烟雾病术后的临床症状和改善其90 d预后,治疗期间不明显增加脑血管事件的发生.%Objective To investigate the application of hyperbaric oxygen therapy(HBOT) on moyamoya disease in adult patients.Methods The consecutive adult patients with Moyamoya disease admitted in the Department of Hyperbaric oxygen,Fuxing Hospital,Capital Medical University from March 2009 to December 2016 were enrolled.The clinical features,effect after HBOT and cerebrovascular events during HBOT were analyzed.The clinical follow-up duration was 3 months.The National Institutes of Health Stroke Scale (NIHSS) was used to score neurological deficit.The Modified Rankin Scale (mRS) was used to score the prognosis of patients.Results A total of 13 adult patients with moyamoya disease were enrolled into this retrospective study,including 8 cases of ischemic lesion and 5 cases of hemorrhage lesion.In patients with ischemic lesion,4 patients were bilateral hemispheres involvement and 4 patients were unilateral involvement,5 patients were treated with revascularization surgery and complicated with cerebral infarction.In patients with hemorrhage lesion,3 patients showed ventricle hemorrhage,2 patients showed cerebral hemorrhage broken into ventricles,and all these patients were treated with evacuation of hematoma/or ventriculopuncture.The neurological deficit scores of all patients were poor before hyperbaric oxygen therapy.The number of HBOT ranged from 5 to 40 sessions.The clinical symptoms of 12 patients were improved after HBOT,1 patient was invalid,2 patient re-showed cerebral infarction during HBOT,10 patients had good prognosis at 3 months (mRS ≤3).Conclusion HBOT can effectively reduce the postoperative symptoms of moyamoya disease in adult patients and improve prognosis at 90th days,meanwhile HBOT does not significantly increase the occurrence of cerebrovascular events.